1. Rural Health Care Curriculum Assessment
Ruth Westra DO, MPH
University of Minnesota
Medical School Duluth
STFM April 29, 2006

2. Department of Family Medicine and Community Health Duluth
University of Minnesota
Medical School Duluth established in 1972
Funding received from Title VII HRSA Academic Administrative Grant

3. The University of Minnesota Medical School Duluth is a campus of the University of Minnesota Medical School mandated by the state legislature with the first class of medical students matriculating in 1972.
Department of Family Medicine and Community Health 2005

4. Duluth MN
Great University on a Great Lake-Lake Superior

5. Mission: Duluth Campus
The mission of the University of Minnesota Medical School Duluth is to educate students who will practice family medicine and other primary care specialties in rural Minnesota and American Indian communities, to provide high quality academic and clinical education programs for professional, graduate and undergraduate students, and to create distinguished research programs that advance knowledge in the health sciences, including rural and American Indian health issues.

6. Duluth Campus NRMP Residency Match
2005 Family Medicine 42.1%
2005 Primary Care 64.9%
2006 Family Medicine 35.9%
2006 Primary Care 64.2%

7. Family Medicine Outcomes Duluth Campus

8. Duluth Campus

9. Admissions Criteria Rural background Service
Desire to become a rural family physician
MCAT/GPA

10. Changes in Curriculum
Rural Course to reinforce the choice for rural family medicine began 2002
HRSA Grant Objective to augment Rural Preceptorship
Summer elective course connected to rural hospitals began 2003
Rural Course began in 2002
Expansion of Rural Preceptorship from 9 days to 12 days. New session at the end of the first year. Continuation of the 3-3 day experiences in the second year. Addition of assignments and community service.

11. Rural Curriculum Intro to Rural Primary Care Medicine
Rural Preceptorship
Rural Community Service
Summer Internship in Medicine Program
Behavioral Medicine and Clinical lectures with emphasis on rural health

13. Timeline Year 1: Rural Course June RP
Summer Internship in Medicine Program
Year 2: Nov RP Feb RP March RP

14. Introduction to Rural Primary Care Medicine
Rural Course 20 Hours
Community Experience
Lectures
Small groups
Panel of Rural Physicians
Community Presentation by the medical students
Site visit to 3 Rural Communities: Grand Rapids, Hibbing and Moose Lake

17. Euclid-Hibbing Mining

18. Wabasha MN

19. Rural Preceptorship Expanded from 9 days to 12 days
Assignments with wrap-up sessions
Community Service
2002: 9 days (3-3 day session in 2003)
2003 and 2004: 12 days (4-3 days sessions with first session the end of the first year of medical school)
Assignments: Clinic Information, Respiratory Infections, Occupational Injuries, Diabetic Foot Exam: Diabetes,
Community Service (giving back to the community)
Community Service: Kids into Health, Brain Awareness, Miscellaneous Projects-Nursing Homes
Medical Students stay with Rural Family Physicians during the Rural Preceptorship (Dr. Jim Boulger-outstanding matching of rural physicians and medical student…many of the rural physicians are alumni of the University of Minnesota Medical School Duluth campus

20. Rural Preceptorship

21. Rural Preceptorship

22. Summer Internship in Medicine Program
Elective rural clinical/research opportunities during the summer session between Year 1 and 2
Clinical: assigned to a rural community hospital and clinic to observe rural patient care with interprofessional experiences
2003: 20 students
2004: 16 students
2005: 34 students

24. Study Sample Base 2002 Second Year 53 students
2002 Pre and Post Test 55 students
2003 Pre and Post Test 54 students
2004 Pre and Post Test 54 students
Comparison 2002/2003/2004
163 medical students
Base line: 2nd year class in Pre-test in November Post-test in April (Preceptorship 9 days)
2002: Rural Course + 9 days Rural Preceptorship
2003 & 2004: Rural Course, 12 day Rural Preceptorship and Summer Internship Program (20 in 2003 and 16 in 2004)

25. Data Sources Rural Health Care Assessment* Pre and Post-test
Rural Course Evaluation
Rural Preceptorship Evaluation
Summer Internship Evaluation
For this presentation, concentrate on the Rural Health Care Assessment

26. Rural Health Care Assessment
Attitude of gain in knowledge on 18 rural health care topics
Pre and Post-test
Information on future practice plans
Pre-test completed by first year medical students prior to the Introduction to Rural Primary Medicine Course.
Post-test completed at the end of the second year.
Likert scale from (1) not familiar (2) aware of issue (3) moderate knowledge (4)very knowledgeable (5) extensive knowledge
Topics: Rural Community Assessment, Demographics, Compassion, Community physician roles, Health Care structures, Access, Policy and legislation, Tertiary Care, Telemedicine, Interdisciplinary team, Infectious diseases, Occupational Injuries, Environmental Health, Mental Health, Chronic Disease, Alternative and Complementary Medicine, Pharmaceutical Costs, Elderly Health Care

27. Rural Health Care Topics
Rural Assessment
Demographics
Compassion
Physician Roles
Care Structures
Access
Policy and Legislation
Tertiary Care
Telemedicine
Interdisciplinary Team
Infectious Diseases
Occupational Injuries
Environmental Issues
Mental Health
Chronic Diseases
A & C Medicine
Pharmaceutical costs
Elderly Care Issues
Alternative and Complimentary Medicine
Pharmaceutical costs and coverage
Attitude of knowledge increase. Selected the topics included as they were covered in the Rural Course and in the Rural Preceptorship assignments.

28. Results
Base line 2002 Second Year Medical Students increased their attitude of knowledge prior to new additions in the rural curriculum

29. Results With addition of new curriculum, further increase in knowledge
Three issues of greatest knowledge: telemedicine, interdisciplinary team and tertiary care support
Least knowledge gain in policy and legislative issues

30. Analysis of Total Attitude Score
Sum of all ratings for comfort level of knowledge items)
By Group: Pre and Post-test
Positive values show pairs of means that are significantly different.

31. Pre and Post-test Total Attitude Scores
Pre and Post-test Total Attitude Scores for Medical Students ( )

32. RPAP Selection
In the 2004 class, 35/54 students have elected to participate in the Rural Physician Assistant Program (RPAP) in their third year.
Is this a reflection of the changes to the Rural Curriculum?
Increase in the number of students choosing to participate in RPAP.
The 2002 class:
The 2003 class: 19 medical students

33. Discussion Continue to evaluate and improve the rural curriculum
Difficult to determine if additions to the rural curriculum will sustain the number of students choosing to practice medicine in rural Minnesota
Rural Role Mentors vital component of the rural curriculum

34. Acknowledgements
Dr. James Boulger
Phyllis Lindberg
Sue McLeod